When Antibiotics Dont Work
Some patients suffer from recurring sinus infections. If your sinus infection does not improve within five to seven days after you finish the whole course of antibiotics, or if you experience another sinus infection within a few weeks, you may be referred to an Ear, Nose and Throat specialist for treatment.
The Wrong Drug For The Bug
Hersh and colleagues looked at two years worth of information from the National Ambulatory Medical Care Survey, an annual government survey of patients treated in doctors offices, hospital outpatient clinics, and emergency rooms.
They found that instead of prescribing antibiotics targeted to the type of bacteria most likely causing the infection, many doctors were too quick to reach for broad spectrum drugs that kill a wider range of bugs.
Thats a problem for several reasons, Hersh says. The wrong antibiotic may not work as well as the recommended treatment, or, in some cases, carries a much higher risk of serious side effects, he says.
For example, fluoroquinolone antibiotics such as ciprofloxacin and levofloxacin which are frequently prescribed inappropriately for sinus infections in adultscan cause permanent and debilitating damage to muscles, tendons, and nerves.
He also points out that broad-spectrum antibiotics kill more of the bodys protective bacteria, leaving people vulnerable to opportunistic infections from bugs such as Clostridium difficile, or C. diff, which causes a potentially deadly form of diarrhea.
And they are more likely than narrowly targeted drugs to lead to antibiotic resistance.
How Should Augmentin Be Taken
- The usual adult dose is one 500-mg tablet of Augmentin every 12 hours or one 250-mg tablet of Augmentin every 8 hours. For more severe infections and infections of the respiratory tract, the dose should be one 875-mg tablet of Augmentin every 12 hours or one 500-mg tablet of Augmentin every 8 hours. Adults who have difficulty swallowing may be given the 125 mg/5 mL or 250 mg/5 mL suspension in place of the 500-mg tablet. The 200 mg/5 mL suspension or the 400 mg/5 mL suspension may be used in place of the 875-mg tablet.
- Two 250-mg tablets of Augmentin should not be substituted for one 500-mg tablet of Augmentin. Since both the 250-mg and 500-mg tablets of Augmentin contain the same amount of clavulanic acid , two 250-mg tablets are not equivalent to one 500-mg tablet of Augmentin.
- The 250-mg tablet of Augmentin and the 250-mg chewable tablet should not be substituted for each other, as they are not interchangeable. The 250-mg tablet of Augmentin and the 250-mg chewable tablet do not contain the same amount of clavulanic acid . The 250-mg tablet of Augmentin contains 125 mg of clavulanic acid, whereas the 250-mg chewable tablet contains 62.5 mg of clavulanic acid.
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What Are The Side Effects Of Z
The most common Z-Pakside effects are:
- Inflamed pancreas
- Liver problems/jaundice
- Severe stomach pain and/or severe, watery diarrhea which may indicate C. difficile-associated diarrhea and requires immediate medical attention
- Severe skin reaction this requires emergency medical attention
- A serious drug reaction that can affect many parts of the body
Seek medical help right away if you experience fainting, severe dizziness, a fast or irregular heartbeat, or an allergic reaction. Symptoms of an allergic reaction may include hives, difficulty breathing, and swelling of the face, lips, throat, or tongue. You should also seek medical treatment if any of these side effects persist or worsen.
Azithromycin has also caused abnormal changes in the electrical activity of the heart, which can lead to a potentially fatal irregular heart rhythm, according to the U.S. Food and Drug Administration . Patients at risk for developing this condition include those who have low blood levels of potassium or magnesium, have a slower-than-average heart rate, or use drugs that treat abnormal heart rhythms .
If your baby is taking azithromycin and is irritable or vomits while eating or nursing, contact the pediatrician right away.
Talk to your healthcare provider before taking a Z-Pak to discuss all possible side effects and drug interactions. He or she can provide medical advice on how to avoid or treat adverse effects. For example, taking this medicine with food could prevent an upset stomach.
Which Antibiotics Are Best For Sinus Infections In Children
- The antibiotic of choice for both children and adults who are not allergic to penicillin is amoxicillin with clavulanic acid .
- Azithromycin is NOT recommended for sinusitis due to bacterial resistance.
- Cefinir and other cephalosporins are NOT recommended for sinusitis except in combination therapy with clindamycin for children with non-life- threatening allergic reactions to penicillin. In these cases, the cephalosporin of choice is cefixime .
- Levofloxacin or doxycycline are the recommended antibiotics for adults with true penicillin allergies. Levofloxacin can also be considered for the treatment of children with life-threatening allergic reactions to penicillin. Doxycyline is not for use in children.
- Oral decongestants are not recommended for the treatment of sinusitis. Antihistamines may be used if there are underlying seasonal/environmental allergies.
- Nasal steroid sprays and nasal saline flushes can be helpful for sinusitis.
Lou Romig, MD, FAAP, FACEP, Medical Director
After Hours Pediatrics Urgent Care
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How To Use Zithromax
Take this medication by mouth as directed by your doctor, usually once daily with or without food. You may take this medication with food if stomach upset occurs. The dosage is based on your medical condition and response to treatment.
For the best effect, take this antibiotic at evenly spaced times. To help you remember, take this medication at the same time every day.
Continue to take this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a return of the infection.
Antacids containing aluminum or magnesium may decrease the absorption of azithromycin if taken at the same time. If you take an antacid that contains aluminum or magnesium, wait at least 2 hours before or after taking azithromycin.
Tell your doctor if your condition persists or worsens.
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How To Use The Antibiotic Safely In Children
Zithromax is an antibiotic used to treat bacterial infections in adults and children. It is commonly prescribed for ear and sinus infections, pneumonia, and strep throat. It is approved for children 6 months or older and is a good option for kids with penicillin allergies.
Commonly referred to as a Z-Pak or a Tri-Pak , azithromycin also comes as a liquid for kids who are unable to swallow pills. It can be taken with or without food.
This article discusses the use of azithromycin for kids. It details what Zithromax treats and pediatric dosing information. It also explains side effects and drug interactions.
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What Is Amoxicillin What Is Azithromycin
Amoxicillin is a penicillin-type antibiotic, in the same class as ampicillin , piperacillin , and ticarcillin . Penicillin-type antibiotics do not directly kill bacteria, but they stop bacteria from multiplying by preventing them from forming the walls that surround them. Bacterial walls protect bacteria from their environment and keep the contents of the bacterial cell together. Bacteria are unable to survive without a cell wall. Amoxicillin is effective against several different bacteria such as H. influenzae, N. gonorrhoea, E. coli, Streptococci, Pneumococci, and some strains of Staphylococci. Amoxicillin is used to treat bacterial infections of the middle ear, throat, tonsils, larynx , lungs , bronchi , urinary tract, and skin. It also is used to treat gonorrhea.
Azithromycin is a macrolide antibiotic chemically related to erythromycin and clarithromycin used to treat otitis media , tonsillitis, laryngitis, bronchitis, pneumonia, sinusitis, uncomplicated skin and skin structure infections, Mycobacterium avium complex, acute bacterial flare ups of chronic obstructive pulmonary disease , acute pelvic inflammatory disease, and several sexually transmitted infectious diseases such as nongonococcal urethritis and cervicitis. It is effective against a wide variety of bacteria such as Hemophilus influenzae, Streptococcus pneumoniae, Mycoplasma pneumoniae, Staphylococcus aureus, mycobacterium avium, and many others.
Who Can And Cannot Take Azithromycin
Azithromycin can be taken by adults and children.
It isnt suitable for some people. To make sure azithromycin is safe for you, tell your doctor if you have:
- had an allergic reaction to azithromycin or any other medicines in the past
- liver or kidney problems
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Are There Alternatives To Z
The medications clarithromycin or are sometimes used as alternatives to the Z-Pak, according to Chirag Shah, MD, board-certified emergency medicine physician and co-founder of Push Health. However, these alternatives will not always work to treat the infection for which the Z-Pak was prescribed in the first place, and consultation with ones medical provider is recommended before changing medications.
Fda Okays Single Dose Antibiotic For Pneumonia And Sinusitis
NEW YORK, June 14-The FDA has approved Zmax as a single-dose treatment for adults with pneumonia and certain types of acute bacterial sinusitis and pneumonia, Pfizer announced yesterday.
Having a once-only liquid antibiotic treatment could help improve compliance among older patients, said Pfizer. A single two-gram dose proved more potent than a standard dose of immediate-release Zithromax, with three times more Zmax found in tissue during the first 24 hours, said the New York drug firm.
Results showed that one dose of Zmax was as effective as currently available treatments that must be taken for seven to 10 days, said Joseph Feczko, M.D., a vice president and chief medical officer for Pfizer.
Zmax is released into the small intestine instead of the stomach, said Pfizer, providing a surge in drug levels during the onset of a bacterial infection when the bacterial count is highest.
The drug is designed to treat acute bacterial sinusitis caused by Haemophilu influenzae, Morxella catarrhalis, or Streptococcus pneumoniae, and also community-acquired pneumonia caused by Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, or Streptococcus pneumoniae.
Clinical trials showed diarrhea and loose stools to be the most common complaint associated with Zmax, followed by nausea and abdominal pain. Pfizer said diarrhea cleared up within two days among the Zmax-treated patients.
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Why Antibiotics Didnt Help Your Sinusitis
In one study, it was found that patients who took antibiotics healed at the same rate as patients who took a placebo. In both cases, 40% of patients were symptom free by a week, and the remaining patients symptoms resolved by 10 days. Despite these results, antibiotics are consistently prescribed by doctors for sinusitis.
Why Wont My Sinus Infection Go Away with Antibiotics?
There are few reasons that antibiotics may be ineffective for sinusitis. Antibiotics are only capable of killing bacteria, so inflammation from other sources cant be managed by them. Sinusitis is often a result of a viral infection like a cold or the flu. Viruses replicate by infecting body cells, which makes killing them much more difficult than bacteria. For better and worse, the immune response is the quickest way to manage these infections. Home remedies and over the counter medications can help make being sick more tolerable, but dont actively fight the infection.
Sinus inflammation can also be a result of allergies. Allergies are an overactive immune response to something like pollen or dust. In this case theres no infection to fight, so antibiotics provide no benefit at all. Allergies are best handled by nasal sprays, decongestants, and allergy immunotherapy. Allergy immunotherapy is the best way to prevent allergic sinusitis from becoming a chronic issue. Immunotherapy works by exposing patients to low doses of allergens and reducing the immune response over time.
Can You Take Azithromycin With Bp Meds
If you have to prescribe a macrolide antibiotic to someone on a calcium channel blocker, it makes sense to give azithromycin. As for other classes of blood pressure drugs like ACE inhibitors and beta-blockers they do not seem to be susceptible to the effects of the two antibiotics, according to Juurlink.
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Research Into Antibiotics And Sinus Infections
The guidelines were triggered, in part, by studies finding that antibiotics may not make a difference. About 60% to 70% of people with sinus infections recover without antibiotics, according to the American Academy of Allergy, Asthma & Immunology.
In one study of symptom relief, patients given antibiotics generally did no better than patients not given antibiotics.
This study, published in the Journal of the American Medical Association, observed 240 patients with sinusitis. They were given one of four treatments: antibiotics alone, nasal steroid spray alone to reduce tissue swelling, both antibiotics and the spray, or no treatment.
Patients who got no treatment were as likely to get better than those who got the antibiotics. The nasal spray seemed to help people with less severe symptoms at the beginning of their sinus problem, and seemed to make those with more intense congestion worse.
The patients all had sinus symptoms that suggested a bacterial infection. Sinus problems are also caused by viruses, for which antibiotics definitely offer no help.
Who Cannot Take Z Pack
Who should not take ZITHROMAX? diarrhea from an infection with Clostridium difficile bacteria. low amount of magnesium in the blood. low amount of potassium in the blood. myasthenia gravis, a skeletal muscle disorder. hearing loss. torsades de pointes, a type of abnormal heart rhythm. slow heartbeat.
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The Rise Of Antimicrobial Resistance
Today, doctors have a better understanding of which antibiotics are best used for which illnesses and how the overuse of antibiotics like Z-paks contribute to antibiotic resistance. The more we use antibiotics inappropriately, the more we create bacteria that are resistant.
Its interesting that we used to think of azithromycin as a cure-all for everything, because thats what led to overprescribing and its demise, said Emir Kobic, a clinical pharmacy specialist in infectious diseases at Banner – University Medical Center Phoenix. Its no longer the first line antibiotic physicians should be prescribing for patients with community-acquired pneumonia where Streptococcus pneumoniae still tends to be the most common bacterial culprit.
The inappropriate use and overuse of Z-paks has led Streptococcus pneumoniae resistance rates to rise as high as 20-30% in America, Dr. Kobic said. This stat should be concerning, because the majority of pharmaceutical companies are not investing to develop new antibiotics, and if they are patients will be paying higher co-pays and out of pocket costs on future antibiotics.
How Long Does Z Pack Stay In Your Body
. Herein, is azithromycin a strong antibiotic?
Azithromycin is an antibiotic that can help treat certain bacterial infections. It is generally safe to use while breastfeeding, but people with existing heart conditions should avoid this drug. Like all antibiotics, azithromycin can only fight certain bacteria.
Also Know, how long after taking Z Pack will I feel better? If your doctor has prescribed azithromycin capsules, you should take them at least 1 hour before food or 2 hours after eating. If you have tablets or liquid, you can take them with or without food. For most infections you should feel better within a few days, but you should still finish your full course of medicine.
Subsequently, question is, how often can you take a Zpack?
Adult dosage Typical dosage is 500 mg once per day for three days. Your doctor may also prescribe 500 mg taken as a single dose on day 1, followed by 250 mg once per day on days 2 through 5.
What are the serious side effects of azithromycin?
Commonly reported side effects of azithromycin include: diarrhea, loose stools, and nausea. Other side effects include: abdominal pain, and vomiting.
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Can I Use Azithromycin Or Amoxicillin While Pregnant
Your healthcare provider will determine the best antibiotic to use if you are pregnant and need an antibiotic. Azithromycin is a pregnancy category B, but there have not been well-controlled studies in pregnant women. Amoxicillin is also a pregnancy category B, and like azithromycin, there have not been adequate studies with pregnant women. Therefore, azithromycin or amoxicillin should be prescribed if benefits to the mother outweigh risks to the baby, and under close observation of the healthcare provider.
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When Antibiotics Are Needed
Antibiotics can help eliminate bacterial sinus infections. But when a sinus infection is caused by allergies, a virus, or a structural defect of the sinuses, other treatments may be necessary.
Allergists and other specialists recommend limiting the use of antibiotics for situations when the symptoms seem to be caused by a bacterial infection.
- Symptoms lasting over seven to 10 days
- A fever is present
- Clear and definite signs of a bacterial infection, such as redness, swelling, or pus
Which Antibiotics Are Most Effective For Bacterial Sinusitis
Antibiotics are indicated for sinusitis that is thought to be bacterial, including sinusitis that is severe or involves the frontal, ethmoid, or sphenoid sinuses, since this type of sinusitis is more prone to complications. Penicillins, cephalosporins, and macrolides seem to be equally efficacious. A 5- to 10-day regimen of amoxicillin 500 mg 3 times a day is recommended as first-line therapy.
One study suggests that a single dose of 2 g of extended-release azithromycin may be more effective than a 10-day course of amoxicillin/clavulanate. However, azithromycin is not likely a good choice in sinusitis because symptoms may improve only because of the anti-inflammatory efficacy of the agent and because it has poor efficacy against S pneumoniae and H influenzae. The risk of adverse effects should be weighed against the severity of disease and patient comorbidities prior to initiating antibiotic treatment.
Patterns of bacterial resistance should also be taken into account in the choice of antibiotic.
Lucas JW, Schiller JS, Benson V. Summary health statistics for U.S. adults: National Health Interview Survey, 2001. Vital Health Stat 10. 2004 Jan. 1-134. .
Slavin RG, Spector SL, Bernstein IL, Kaliner MA, Kennedy DW, Virant FS, et al. The diagnosis and management of sinusitis: a practice parameter update. J Allergy Clin Immunol. 2005 Dec. 116:S13-47. . .
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